Tuesday, October 4, 2016

Making Sense of the World - Nature, Nurture and Beyond

Our mental health reflects a complex and turbulent dance between nature and nurture. But we are not merely passive slaves to these forces, we actively learn about, make sense of and respond to the world. The essential added element in the 'nature-nurture' debate, too often overlooked, is human psychology itself.

We are biological creatures. It is an undeniable fact that neural activity and chemical processes in the brain lie behind all human experiences. It is therefore very common to assume that our distressing emotions or inexplicable behaviour must stem from illnesses or disorders of the brain. And, from that perspective, individual differences in mental health outcomes (why some of us experience psychological problems while others are more fortunate) are best explained in terms of individual differences in biology or genetics.

It's undoubtedly helpful to understand more about how the human brain works. But the human brain is not only a complex biological structure, it is also a fantastically elegant learning engine. We learn as a result of the events that happen to us, and there is increasing evidence that our mental health problems are not merely the result simply of faulty genes or brain chemicals. They are also a result of learning: a natural and normal response to the terrible things that can happen to us and that shape our view of the world.

There is very powerful evidence that even serious problems as hallucinations and delusional beliefs are associated with traumatic childhood experiences (poverty, abuse, etc.). And it is important to remember that the recent economic recession has had a direct impact on suicide rates - a rather dramatic (and sad) example of how social factors impact on our mental health.

Fundamentally, our mental health depends on how we understand our world, our thoughts about ourselves, other people, and the future. Biological factors, social factors, circumstantial factors - our learning as human beings - affect us as those external factors impact on the key psychological processes that help us build up our sense of who we are and the way the world works.

This means we should think differently about the 'nature - nurture' argument, and add a third factor; human psychology. It's absolutely true that biological factors are important in mental health, and that biological differences can partially explain individual differences in mental health. But that happens if those biological factors affect the way in which we think - how we make sense of ourselves and the world. And that is equally true for environmental factors. The events we experience in our lives also affect our psychological make up and how we make sense of the world around us. In rather more technical language, the effects of nature and nurture are mediated by psychological factors.

This approach to psychological wellbeing is diametrically opposed to the traditional 'disease-model' of mental illness, and should change how we help people in distress. We should replace diagnoses with straightforward descriptions of people's problems, radically reduce use of medication, and use it pragmatically rather than presenting it as a 'cure'. Instead, we need to understand how each person has learned to make sense of the world, and tailor help to their unique and complex needs. We need to offer care rather than coercion, to fight for social justice, and to establish the social prerequisites for genuine mental health and wellbeing.